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Tonsillectomy without craniectomy for the management of infantile Chiari I malformation
Jorge A Lazareff1, Marcelo Galarza, Toorai Gravori
1Division of Neurosurgery, University of California at Los Angeles School of Medicine, 90095-7039, USA. Jlazareff@mednet.ucla.edu
Insights
Resecting or shrinking cerebellar tonsils without bone removal effectively managed Chiari I malformation in pediatric patients. Symptoms improved, and syringomyelia reduced in most cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
Background:
- Chiari I malformation involves cerebellar tonsil herniation.
- Surgical management traditionally includes craniectomy or laminectomy.
Purpose of the Study:
- To evaluate the efficacy of tonsillar resection or shrinkage without bone removal for pediatric Chiari I malformation.
Main Methods:
- 15 pediatric patients underwent tonsillar resection (7) or shrinkage (8) via occipitoatlantal incision.
- Procedures were performed without craniectomy or laminectomy.
- Mean follow-up was 7 months.
Main Results:
- All patients showed symptom improvement.
- Syringomyelia resolved in 7 of 8 affected patients.
- Gliosis with cortical atrophy noted in resected tissue.
Conclusions:
- Cerebellar tonsil removal can be sufficient for symptom relief in Chiari I malformation.
- Minimally invasive tonsillar procedures offer a viable alternative.
Object:
The authors report their experience with 15 pediatric patients who underwent resection or shrinkage of the cerebellar tonsils without craniectomy or laminectomy, for the management of Chiari I malformation.
Methods:
The procedure was performed in six boys and nine girls with a mean age of 10 years. Thirteen patients presented with the congenital form of this disorder and two patients with Chiari I malformation caused by lumboperitoneal shunting. Clinical complaints included headaches (seven patients), scoliosis (four patients), numbness of the extremities (four patients), and upper-limb weakness (two patients). Two patients presented with failure to thrive and one with vocal cord palsy. Eight patients (six girls and two boys) had syringomyelia. The patients' symptoms had developed within a mean time period of 21 months (range 1-70 months). In all patients the cerebellar tonsils were exposed through a dura mater-arachnoid incision at the occipitoatlantal space. In seven patients the tonsils were resected and in the remaining eight patients the tonsils were shrunk by coagulating their surfaces. All patients improved postoperatively. Gliosis with cortical atrophy was observed in the resected neural tissue. Syringomyelia was reduced in seven of eight patients. The mean length of the follow-up period was 7 months.
Conclusions:
Removal of herniated cerebellar tonsils can be sufficient for alleviating symptoms in patients with Chiari I malformations.